Weighing the pros and cons – choosing the appropriate timing for surgery First, not all congenital cataracts require surgical treatment. Congenital cataracts with non-critical clouding or fine clouding in the visual axis area should not be treated prematurely with surgical intervention. Non-surgical treatment and follow-up to observe changes in the condition are generally recommended. For congenital cataracts with cloudiness or total whiteness in the critical area of the visual axis, early surgical treatment should be recommended for both monocular and binocular onset. Secondly, the timing of surgical treatment should take into account the general (anesthetic) tolerance of the child, the postoperative inflammatory response of the eye, and the sensitivity period of visual development. The cataract specialist will only be able to choose the best timing for the individualized treatment of the child if he or she takes a comprehensive view of the child’s congenital cataract and weighs the pros and cons. Histocompatibility – Choosing the right artificial lens (IOL) The choice of an artificial lens includes the choice of material and the choice of degree. First, acrylic IOLs are usually chosen for children with congenital cataracts. The acrylic material is ideal for microincision cataract surgery and has been widely used by cataract patients since its introduction. Not only is it highly safe, but its high degree of biocompatibility is also recognized by physicians and cataract patients. It is also easy to be compressed and once implanted in the eye, the lens can smoothly unfold and regain its initial shape without damage. Secondly, the choice of lens diopter is still a challenge as far as it goes. The timing of implantation requires a different number of IOL diopters. The timing of IOL implantation in children needs to be based on the child’s age at surgery, the development of the eye (eye axis, corneal curvature and diameter), the eye type of surgery, and the compliance with postoperative spectacle correction. According to the common international standard, the target refraction of the implanted lens at age 7 is calculated as 0, and each year of age is reduced by one D. This standard is still in use. Strengthening anti-inflammation – reducing postoperative complications The strong postoperative inflammatory response in children with congenital cataract is the most important cause of postoperative complications, such as anterior chamber exudation, postoperative high intraocular pressure, iris adhesions, pupillary membrane closure, and epithelial cell proliferation following hairpin formation. First of all, in order to strengthen anti-inflammation, we recommend the application of antibiotic combined with glucocorticoid eye drops on the 1st postoperative day in children, along with combined NSAIDs 6 times/day, and antibiotic combined with glucocorticoid eye ointment on the eyes at bedtime for 2 weeks, followed by the above eye drops 4 times a day for 1 month, after which the hormonal eye drops can be discontinued and NSAIDs continue to be used 4 times a day, which can be maintained until the postoperative period of 3 months. Second, while using postoperative anti-inflammatory drugs, it is important to monitor the possible side effects of the drugs. Our study found that the occurrence of high IOP in the early postoperative period in children with congenital cataract is closely related to the postoperative inflammatory response, but also to the sensitivity to glucocorticoid drugs. In some children with well-controlled inflammation, the IOP can be reduced to the normal range when the glucocorticoids are discontinued and replaced by simple use of nonsteroidal anti-inflammatory drugs. Amblyopia treatment – to promote post-surgical vision recovery Amblyopia treatment is the most important means to promote post-surgical vision recovery in children. First, correction of the refractive error that may remain after surgery, especially in aphakic children, is recommended at the one-week postoperative review for optometry and prescription. It is recommended that the child’s refractive error be reviewed periodically (every 3 months) and that the glasses be replaced if necessary. School-age children should also consider the functional needs of near and distance vision in their prescription. Secondly, masking is the best way to treat amblyopia after monocular cataract surgery (or a large gap in vision after bilateral cataract surgery). The duration and method of masking for the dominant eye should be considered according to the degree of amblyopia and the age of the child. Further, vision training is performed using amblyopia therapy devices and other modalities. Generally, before the age of 3, it is difficult for the child to do some fine visual training, so for the younger children, glasses and simple visual games for daily life should be trained; after the child is able to cooperate, fine visual training with amblyopia therapy devices should be done in time. Finally, follow-up is also very important for children, as it is the key to timely detection and management of postoperative complications and to promote vision recovery. We recommend long-term follow-up for all children, once every 2-3 months, for at least 5 years. Warm tip: Not all surgery for congenital cataracts is better as early as possible. Only when a comprehensive consideration is made and the pros and cons are weighed can we choose the best time for individualized surgery for the treatment of the child. The choice of IOL material requires a focus on histocompatibility and the timing and degree of implantation based on the child’s age at surgery, the development of the eye (eye axis, corneal curvature and diameter), the eye type of surgery, and compliance with postoperative spectacle correction. Strengthening postoperative anti-inflammation and monitoring possible side effects of medications are key to reducing postoperative complications. Standardized amblyopia treatment and regular postoperative follow-up can better promote postoperative vision recovery in children.